Ankylosing Spondylitis and Your Mental Health

M.A., Health Writer
View as:|
1 of 11
Next
iStock

Ankylosing spondylitis (AS), a type of chronic inflammatory arthritis of the spine, can affect more than the body. Other joints can also become inflamed, and you might develop related conditions, such as uveitis or iritis in your eye, psoriasis, heart problems, Crohn's disease, or colitis. You're also more likely to have some mental health problems, says AS expert Nigil Haroon, M.D., Ph.D. in a phone interview with HealthCentral, of the Krembil Research Institute in Toronto, and he wants you to understand why and how to manage.


iStock

Ankylosing spondylitis demographics changing

First, here's some helpful background. There's a 10-percent chance that a child of an affected parent will develop this musculoskeletal system disorder, Dr. Haroon says. It can affect a child as young as 8, but peak incidence is between 15 and 40. It was considered to be more common in men, but with advances in imaging such as magnetic resonance imaging (MRI), more women are being diagnosed, as he reported in BMJ Open in 2014. Men tend to have more spinal damage, but pain levels in both genders appear to be equal.


iStock

Move it and use it

An AS diagnosis can be particularly difficult for young people who must manage severe pain and stiffness in their spine. "At this age, they'd normally run, play, and compete with friends, but they can’t," Dr. Haroon says. "They need to stand up and stretch frequently, since lack of mobility leads to more stiffness. The exact cause isn't known, but stagnation of inflammation-causing molecules may cause this. Keep moving: Pain and inflammation aren't due to wear and tear, unlike osteoarthritis."


iStock

Depression pairs with AS

It's common sense that managing a chronic condition might cause someone to be sad or depressed, but in science, hypothesis isn't enough. Dr. Haroon points to the grandfather of studies about this, a systematic review of 16 reports, published in July 2018 in Arthritis Research & Therapy. "Depression is common among (AS) patients and is associated with more severe disease activity and functional impairment," it said. "Identifying and managing depression should form part of their holistic care."


iStock

Think how you feel

Patients naturally get anxious about whether a treatment will "work" and how, Dr. Haroon says. After exhausting anti-inflammatory medications, the next step is a biologic. "With biologics, there's a 50-to-60-percent chance you'll experience a 50-to-60-percent improvement in symptoms. Their use has made a world of difference. If you don't respond to the first biologic, you may respond to another one. We don’t currently have a mechanism to predict ‘your’ biologic from the start."


iStock

Stats show mental health relationship

A 2016 study in the Journal of Rheumatology found that AS might increase the risk of a subsequent newly-diagnosed depressive disorder, anxiety disorder, or sleep disorder, but not schizophrenia or bipolar disorder. Dr. Haroon estimates perhaps 10 percent of his AS patients report depression, "which is likely underreported and representative of those with moderate to severe depression,” he says.


iStock

Beware self-harm tendencies

Dr. Haroon was an author of a study presented at the Annual European Congress of Rheumatology meeting in Amsterdam in 2018. An abstract of the study was then published in Annals of Rheumatic Diseases and reported increased rates of self-harm attempts following an AS diagnosis among more than 14,000 patients. His research team emphasized more awareness, and routine evaluation of self-harm behavior when managing people with chronic inflammatory arthritis.


iStock

Early diagnosis is the goal

"You can lead a very productive life, with a high quality of life, if you commit to taking care of yourself," Dr. Haroon says. "It's important to identify or diagnose AS early and also identify the appropriate treatment. You should play a major role in your treatment, by getting enough exercise, eating healthy, controlling your weight, and getting quality sleep — just like everyone else should do, too. Doing these things can also help improve your mood."


iStock

You may need several tests

When it comes to diagnosis, a blood test may reveal inflammation in only 30 to 40 percent of those tested — much lower compared to rheumatoid arthritis (RA)— says Dr. Haroon. "Negative blood tests don't mean you don't have inflammation. An X-ray of the sacroiliac (SI) joints may not show anything abnormal in early stages of AS, but a special MRI with STIR sequences — short tau inversion recovery — can detect inflammation. Early diagnosis increases chances of successful treatment, to help you lead a more normal life."


iStock

Early identification not so easy

Early diagnosis can be challenging for a physician who sees a lot of patients complaining of back pain, Dr. Haroon says. "We can 'see' rheumatoid arthritis inflammation visible in the hands, but seeing AS inflammation in the spine is not possible. If you're less than 40, have had back pain for three months without a definitive cause, and you have a family member with this condition, or with IBD (inflammatory bowel disease) or uveitis, suspicion should be much higher."


iStock

Mental problems don't help pain

A positive response to treatment goes far in helping you have more confidence about engaging in normal activities, which also boosts mood, Dr. Haroon says. "Anxiety and depression will affect how you feel, even with treatment, and pain may not respond so well if you have either. If a multidisciplinary team directs your treatment, you may have access to a physical therapist, pain specialist, and mental health professional such as a social worker, psychologist or psychiatrist."